High blood pressure (hypertension) is a problem for many women these days. Approximately five percent of pregnant women have chronic high blood pressure.
In the infertility population the percentage of women with chronic high blood pressure is even higher. That’s because the average woman with infertility is older and has a higher incidence of medical problems than the general population of pregnant women.
So what are the goals of the infertility doctor when a patient presents for fertility treatment with chronic hypertension? The first goal is to determine if there is end organ damage, which is harm to major organs fed by the circulatory system, and get the blood pressure under control, even if it requires medication. The second goal is to help the patient keep her blood pressure normalized and to try to achieve this without medications.
We need to control blood pressure at this point before fertility treatments succeed, because high blood pressure and pregnancy are a dangerous combination.
Early in pregnancy the blood pressure actually decreases, but in the second and third trimesters of pregnancy it rises naturally. For women with pre-existing high blood pressure, the second and third trimesters can present unique challenges and pose risks to the developing child.
Women with high blood pressure who are pregnant have a higher incidence of pre-eclampsia, fetal growth restriction, neonatal morbidity and cardiovascular disease. Severe hypertension occurs more often in women with pre-existing chronic high blood pressure and can lead to eclampsia, stroke, heart attack and placental abruption.
High blood pressure challenge for infertile women
Obesity, high cholesterol, stress, no time for exercise, all these can lead to high blood pressure. Some women also can inherit a tendency to get high blood pressure. Knowing what to do about your high blood pressure before you get pregnant is not as clear-cut as you may think.
Surely, following a healthy diet and exercising are part of the pre-pregnancy goals, but doctors have debated about whether to start medication to lower your blood pressure. There are clear and current guidelines that recommend medication if the blood pressure is greater than 160/105 persistently when at rest. However, if your blood pressure is greater than 140/90, that is still considered hypertensive (having high blood pressure).
But new data shows that treating this level of high blood pressure with medication is not always helpful, unless there is evidence of end organ disease, which includes kidney and heart disease. This is what I check for in infertile women with hypertension.
The challenge for the infertile patient is that bringing her high blood pressure down may take time. Therefore, taking steps now to get your blood pressure to 120/80 and keeping it there is the best way to ensure a healthy pregnancy through fertility treatment.